Class 5 Basic Life Highlight Sheet for Goshen Community Schools

Plan Highlights Group Basic Life / AD&D Insurance Goshen Community Schools ELIGIBILITY AD&D SCHEDULE EachActiveFull-TimeNon Certified Personnel regularly working a For Accidental Loss of Amount Payable Life 100% minimum of 30 hours per week who were hired prior to January Both Hands 100% 1, 2012 and all Active Full-Time Non Certified Personnel of the Both Feet 100% Employer regularly working a minimum of 30 hours per week Sight of Both Eyes 100% who were hired after January 1, 2012 as well as Bus Drivers of One Hand and One Foot 100% One Hand and Sight of One Eye 100% the Employer regularly working a minimum of 16 hours per week One Foot and Sight of One Eye 100% during the school year working 20 hours or more per week, Speech and Hearing 100% except any person working on a temporary or seasonal basis. One Hand 50% One Foot 50% BENEFITAMOUNT Sight of One Eye 50% BasicLifeandAD&D: $25,000 Speech 50% Hearing 50% GUARANTEEDISSUE For Total Loss of Amount Payable $25,000 Both Arms and Both Legs 100% Both Arms and One Leg or 75% CONTRIBUTIONREQUIREMENTS Both Legs and One Arm Coverageis100%EmployerPaid. Both Arms 67% Both Legs 67% One Arm and One Leg 67% One Arm or One Leg 50% BENEFIT REDUCTION DUE TO AGE Age Original Benefit Reduced to 70 50% FEATURES  Accelerated Death Benefit  Air Bag Benefit  Conversion Privilege  FMLA/MSLA Extension  Portability  Seat Belt Benefit  Waiver of Premium VALUE-ADDED SERVICES  Bereavement Counseling Services  Travel Assistance Services www.reliancestandard.com This Plan Highlight is not a complete description of the insurance coverage. Insurance is provided under group policy form LRS-6422, et al. This is not a binding contract. Should there be a difference between this Plan Highlight and the contract, the contract will govern. The Certificate of Coverage will be made available to you that describes the benefits in greater detail; however a benefit will not be paid if caused or contributed by an exclusion listed in the Certificate. Reliance Standard Life Insurance Company is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In New York, insurance products and services are provided through First Reliance Standard Life Insurance Company, Home Office: New York, NY. Product features and availability may vary by state.